text: If you're among the approximately one million Americans destined to have a heart attack this year, hope that it doesn't happen on a weekend. Many U.S. hospitals aren't set up to provide state-of-the-art treatment for heart attacks on a 24/7 basis. The largest ones are equipped.  Massachusetts General Hospital has one of Boston's busiest emergency rooms. On one afternoon this week, all the chairs were filled with patients waiting to be seen. But cardiologist Jim Januzzi says there is no wait for a patient who comes in with chest pain. Doctors and nurses leap into action to see whether that patient is having a heart attack.  "The moment the patient hits the door, the clock runs," Januzzi says. "So the faster a heart attack is recognized, the shorter the door-to-balloon time will be." Door-To-Balloon Time "Door-to-balloon time" is the biggest catch phrase in heart care today. It starts when a heart attack patient enters the emergency room door... and ends when a tiny balloon, threaded into a blocked coronary artery, is inflated. That restores blood flow, and aborts the heart attack. If the Massachusetts General emergency room crew diagnoses a heart attack, the patient is sent immediately to the ninth-floor cardiac catheterization lab for the balloon procedure, known as angioplasty, anytime of the day or night. "There's no discussion, there's no debate, there's no negotiating," Januzzi says. "The phone call gets made, and the cath lab is opened. And so if it's a weekend night, it gets opened." That's not the case everywhere. "The reality is that there are many institutions nationally that do angioplasty five days a week during the working hours and do not have an open cath lab at night or on the weekends," Januzzi says. In fact, most U.S. hospitals don't have the capacity to do emergency angioplasty anytime, even though that has been the standard of care for serious heart attacks for several years now. Costing Lives Several studies show that the inability of hospitals to do emergency angioplasties anytime is costing lives. The latest is in this week's New England Journal of Medicine. Researchers studied every heart attack patient in New Jersey over a 15-year period. William Kostis of the Robert Wood Johnson Medical School led the study. He says those who suffered their attacks on weekends were more likely to die, largely because they were much less likely to get angioplasty right away. "The main point is that there's one in 100 people who die unnecessarily when they're admitted over the weekend," Kostis says. "One out of 100 is a very large difference in medicine." There are two reasons why it's significant for heart attack care. First, only about one in 10 heart attack victims dies these days. So a 1 percentage-point increase in deaths amounts to a 10 percent increase in the death rate. Second, nearly a million Americans suffer heart attacks every year. So the higher weekend death rate translates to thousands of unnecessary deaths. Kostis says it is an urgent problem. "We have identified a difference in outcomes of people who have heart attacks and present to hospitals on weekends," he says. "The next step will be for people to say: What are we going to do about it?" For one thing, many hospitals are trying to shorten their door-to-balloon times. "People are very, very worried about making sure our door-to-balloon times are faster than other places," says Januzzi of the Massachusetts General, "because we want to make people realize that we're really doing this. We're really making a commitment. We're not sort of lollygagging our way into the cath lab. You know, when we get called... we move!" The American Heart Association and the American College of Cardiology say heart attack patients should get angioplasties within 90 minutes of the time they enter the hospital. But one recent study found only one in five hospitals gets it done that fast. And those are the hospitals that offer emergency angioplasty. More hospitals are joining those ranks in response to cajoling from heart care experts, and also in response to studies like the one published today. Providing Quality Care "The truth hurts," Januzzi says. "Institutions want to be able to say they provide high-quality care for heart attacks. But it takes a serious commitment. The commitment needs to be 24 hours a day and seven days a week." That's not easy. Januzzi says that at the minimum, it takes a crack team of two experienced cardiologists, two trained nurses and a couple of cardiovascular technicians. Not every hospital can muster that. Many authorities say there should be a regional system of heart attack care, much as there is for serious trauma care. Hospitals that can't offer angioplasty around the clock could be set up to refer heart attack patients promptly to those who do. Meanwhile, people worried about a heart attack should find out which hospitals in their area offer 24/7 angioplasty — and get there fast if they suffer chest pain, shortness of br